Factors associated with oral health-related quality of life in patients with diabetes.

BACKGROUND: Oral pathologies are prevalent in diabetes, and they may affect the quality of life and patient's perception of their oral health. The aim of this study was to investigate the factors associated with oral health-related quality of life of patients with diabetes. METHODS: A cross sectional study was conducted involving 316 patients visiting a hospital diabetic unit. Sociodemographic, oral and medical care data were recorded, and a General Oral Health Assessment Index (GOHAI) questionnaire was completed. A multivariable analysis was performed. RESULTS: Of the 316 study participants, 61.7% had type 2 diabetes (T2DM) and 20.5% had poorly controlled diabetes. Forty-five percent had at least one oral complication, 55% had visited a dentist within the past year and 67% reported having poor oral health and 281 answered the GOHAI questionnaire. A low GOHAI score (≤50) was obtained for 24.6% of the patients and was associated with T2DM, poorer oral health, dry mouth sensation and use of a removable prosthesis. CONCLUSIONS: Oral health status was poorer and had a negative effect on the quality of life among patients with T2DM, possibly contributing to poorly balanced nutrition.

[Papillomavirus and head and neck cancer]. / Papillomavirus et cancers des VADS.

Tobacco and alcohol consumption are the main risk factors for head and neck cancers. Papillomavirus (HPV) infection was recently associated with the development of malignant tumors of the oropharynx, according to molecular and biological arguments. We describe the oncogenic mechanisms of HPV infections, the epidemiological and clinical aspects of associated head and neck cancers, their prognosis, and issues of specific therapeutic strategies.

Reduced susceptibility to amoxicillin of oral streptococci following amoxicillin exposure.

As antibiotic pressure often triggers bacterial resistance, the use of short-duration therapies is increasingly recommended. The objective of the present study was to evaluate both the clinical efficiency and the impact on oral streptococci of a 3 day versus a 7 day amoxicillin therapy for odontogenic infection requiring tooth extraction. On day 0, patients were randomly assigned to a 3 day or 7 day amoxicillin treatment. The tooth was extracted on day 2 and the post-operative follow-up was carried out on day 9. Oral flora was collected on days 0, 9 and 30, and the susceptibility of the streptococci to amoxicillin was determined. The results showed that treatment with amoxicillin for 3 or 7 days had a similar clinical efficiency, and also induced similar selection of oral streptococci with reduced susceptibility to amoxicillin, suggesting that the selection of strains with reduced susceptibility to amoxicillin is a rapid phenomenon, appearing even with short-duration therapies.

[Dental status, access to care and precariousness]. / Etat dentaire, recours aux soins et précarité.

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

Effects of excitatory amino acid receptor antagonists on pulpal blood flow of the rat mandibular incisor.

Pulpal blood flow (PBF) changes have been monitored by laser Doppler flowmetry on rat mandibular incisors. Electrical stimulation (10 sec, 50 microA, 2 ms, 20 Hz) of one incisor induced a blood flow decrease followed by a blood flow increase. The effect of intravenous administration of antagonists of ionotropic glutamate receptors (iGluRs) and antagonists of metabotropic glutamate receptors (mGluRs) was compared with that of those obtained from animals treated with the vehicle alone. No long-term effect on basal PBF was observed, except a remaining increase of 34.5% (p < 0.05, n = 5) for ketamine (10 mg/kg), an iGluR antagonist, and of 37% (p < 0.05, n = 5) for MCPG (7.5 mg/kg), an mGluR antagonist. In animals treated with iGluR antagonists, acute changes in PBF after stimulation were not significantly different from those observed with vehicle. In animals treated with mGluR antagonists, the blood flow decrease was significantly enhanced in amplitude and duration for MCPG (7.5 mg/kg), respectively, +73% and +92% (p < 0.05, n = 5). These results suggest that Group I mGluRs participate in the regulation of the immediate pulpal blood flow decrease induced by electrical stimulation of the lower incisor in the rat.

Superficial architecture of the jaw-closing muscles of the cat (Felis catus): the temporo-masseteric complex.

The muscle fiber fascicles of the temporo-masseter complex of the cat were minutely dissected. Some heads were embedded in paraffin while others were put into methyl-methacrylate resin and sections were made. The results of this anatomical study demonstrate that this complex consists of the masseter muscle, the temporal muscle and two well individualized transitional fascicles: the maxillomandibularis and zygomato-comandibularis muscles. The masseter and temporal muscles are composed of individualized compartments in which the orientation and aponeuroses of the fibers of which they are composed differ with regard to the centric occlusion plane. The masseter muscle consists of a superficial fascicle made up of two layers, an intermediate fascicle, and a deep fascicle composed of two layers. The temporal muscle consists of one anterior orbital part and one posterior temporal part. This structure is in accordance with the mammalian archetype described by Gaspard and Saban. These findings should lead towards a homology-based nomenclature founded on comparative anatomy studies of mammalian species. Such a classification would permit the comparison of results obtained from physiological and histochemical studies of these complex muscle fibers when they are published by different researchers.

Effects of BP 2-94, a selective H(3)-receptor agonist, on blood flow and vascular permeability of the rat mandibular incisor pulp.

Pulpal blood-flow changes were monitored by laser Doppler flowmetry after electrical stimulation of the mandibular incisor. Stimuli of 10 s (50 microA, 2 ms, 20 Hz) were applied to the incisors of untreated animals and longer stimulations (5 min) were applied in animals treated with the alpha-blocker phenoxybenzamine. Changes in vascular permeability in the dental pulp were measured by Evans blue extravasation following resection of the superior cervical ganglion. In these groups, a selective agonist of H(3) receptors, BP2-94 (1.5 and 15 mg/kg), and an H(3)-antagonist ciproxifan (1 mg/kg) were administered. The effects of these drugs were compared with those obtained from animals treated only with the vehicle (methylcellulose 1%). Basal pulpal blood-flow was not affected significantly by BP2-94 or ciproxifan. The vasoconstriction induced in the group of intact rats by electrical stimulation of 10 s is decreased in amplitude and duration at the higher dose of BP2-94 by 58 and 40%, respectively (P<0.05, n=5). In the sympathectomized animals, plasma extravasation was significantly increased at 15 mg/kg BP2-94 (+100%, P<0.01, n=5). These results suggest that H(3) receptors may participate in the regulation of changes in vessel contraction and permeability provoked by electrical stimulation of the dental pulp. However, the non-selective effects of the H(3) agonists reacting on adrenergic sites and H(1) receptors could explain a part of the results.

[Substance P in the primary sensory neurons innervating the dental pulp in the guinea pig]. / Substance P dans les neurones sensitifs primaires innervant la pulpe dentaire, chez le cobaye.

Primary sensory trigeminal neurons supplying the dental pulp of incisors in guinea pigs were labelled by retrograde axonal transport. Using an autometallographic intensification procedure, 48 h after injection of wheat germ agglutinin/colloidal gold in the pulp, gold particles were detected in the cytoplasm of the neurons as black granulations. A morphometric study showed a bimodal repartition of the labelled neurons of the ganglion. By submitting ganglion slices to an anti-substance P immunserum revealed by immunocytochemistry, it could be observed that, among the neurons supplying the dental pulp of incisors, the majority of the largest were substance P immunopositive while the smallest were substance P immunonegative. These observations suggest that there could be at least two different populations of nerve fibres supplying the guinea pig incisor dental pulp. Substance P negative neurons could express different neurotransmitters.

Effects of RPR 100893, a potent NK1 antagonist, on the jaw-opening reflex in the guinea pig.

RPR 100893 appears as a new potent NK1 selective non-peptide antagonist both in vitro and in vivo, and exhibits high affinity for guinea pig and human NK1 receptor [M. Tabart, J.-F. Peyronel, Synthesis of RPR 100893, prototype of a new series of potent and selective non-peptide NK1 antagonists: the triarylperhydroisoindolols, Bioorg. Med. Chem. Lett., 4 (1994) 673-676.]. Intra-oral administration of RPR 100893 (3, 15, 10, 30 mg/kg) was performed in freely moving guinea pigs during recording of the short- (6-10 ms) and long-latency (18-26 ms) jaw-opening reflex (JOR) elicited by electrical stimulation (0.5 Hz) of the lower incisor tooth pulp. RPR 100893 induced a noticeable and dose-dependent increase of the long-latency reflex thresholds (P<0. 001) but was ineffective on the short-latency responses (P=0.14). The results suggest that, in guinea pigs, the long-latency JOR requires activation of NK1 receptors, while the earlier reflex component, elicited by activation of periodontal afferents, does not. These NK1 receptors could be located either on JOR interneurons activated by tooth pulp afferents or on digastric motoneurons, receiving the tooth pulp input through a polysynaptic pathway.

Reciprocal connections between the red nucleus and the trigeminal nuclei: a retrograde and anterograde tracing study.

An anterograde biocytin and a retrograde WGA-colloidal gold study in the rat can provide information about reciprocal communication pathways between the red nucleus and the trigeminal sensory complex. No terminals were found within the trigeminal motor nucleus, in contrast with the facial motor nucleus. A dense terminal field was observed in the parvicellular reticular formation ventrally to the trigeminal motor nucleus. The parvicellular area may be important for the control of jaw movements by rubrotrigeminal inputs. On the other hand, the contralateral rostral parvicellular part of the red nucleus receives terminals from the same zone in the rostral part of the trigeminal sensory complex, where retrogradely labelled neurones were found after tracer injections into the red nucleus. Such relationships could be part of a control loop for somatosensory information from the orofacial area.

Potentiation of fentanyl suppression of the jaw-opening reflex by transcranial electrical stimulation.

Stinus et al. [L. Stinus, M. Auriacombe, J. Tignol, A. Limoge, M. Le Moal, Transcranial electrical stimulation with high frequency intermittent current (Limoge's) potentiates opiate-induced analgesia: blind studies, Pain, 42 (1990) 351-363.] observed that transcranial electrical stimulation (TCES) with high-frequency intermittent current potentiated opiate-induced analgesia using the tail-flick test. In unanesthetized, chronic preparations, electrical stimulation (0.5 Hz) of the lower incisor pulp of rats elicits a short-(6 ms) and a long-latency (12-18 ms) jaw-opening reflex (JOR) without any evidence of aversive behavior [J. Azerad, F. Fuentes, I. Lendais, A. Limoge, B. Pollin, Methods for selective tooth pulp stimulation in acute and chronic preparations in rats, J. Physiol., 406 (1988) 3P.]. Fentanyl increases thresholds of both reflexes and transiently suppresses the long-latency JOR. We then decided to look at the influence of TCES on both drug-induced mean of maximal threshold variation (MMTV) and duration of JOR suppression period. These parameters have been investigated in 43 Wistar rats with or without TCES administered for 3 h before the drug injection and throughout the testing period. TCES alone has no effect. In contrast, it significantly increases the duration of the reflex suppression period (149 +/- 5% vs. control, P < 0.001) while fentanyl-increased reflex thresholds remain unchanged. The fentanyl-induced JOR suppression period returns to the control values 2 days later. When a second 3-h TCES session is delivered 2 or 4 days after the first TCES session, a similar increase of this suppression period is observed. Moreover, 2 days after a second TCES session, an increase of the duration of the fentanyl-induced JOR suppression period is systematically observed. In contrast, a 6-h TCES session never induces such effects. These results confirm a potentiating effect of TCES on opioid action and demonstrate the value of repeated TCES sessions.

Environmental effects on laser Doppler pulpal blood-flow measurements in man.

The increasing number of experiments using laser Doppler flowmetry in man for pulpal blood-flow recordings leads to questioning of the experimental recording conditions. The present study focused on three points: the design of the laser probe holder, the isolation of the tooth, and the influence of the recording site. A rigid polyurethane splint used in addition to different isolation devices (cotton roll, metal shield, rubber dam) was compared with a silicone splint. The silicone resulted in significantly higher values (+341%) than the polyurethane splint. The combination of the polyurethane splint with isolation devices decreased, in all cases, the flux values. The polyurethane/rubber-dam combination was the most efficient in individualizing the pulpal blood flow (-69% decrease). Recordings on non-vital teeth confirmed the hypothesis that there was periodontal contamination of the recorded flow, as the signal was abolished when using the polyurethane/rubber-dam combination. Cervical recording sites gave significantly higher values than occlusal sites (+42%). It is concluded that, in man, the part played by the periodontium may have been underestimated in previous recordings of pulpal blood flow. The use of a rubber dam in combination with a rigid splint to enhance the validity of recordings is proposed.

Microinfusions of excitatory amino acid antagonists into the trigeminal sensory complex antagonize the jaw opening reflex in freely moving rats.

Microinfusions of EAA antagonists (APV 0.1 microliter 25 mM, gamma-DGG 0.1 microliter 50 mM, CNQX 0.1 microliter 50 mM, ketamine 0.1 microliter 0.2 M) were performed in freely moving rats while recording the long latency jaw opening reflex (JOR) elicited by electrical stimulation of the dental pulp. NMDA and non-NMDA antagonists were applied in the trigeminal sensory complex at the termination of dental pulp afferents. The selective NMDA antagonist APV strongly reduced the amplitude of the polysynaptic JOR. gamma-DGG and ketamine, which are broader spectrum NMDA antagonists, showed similar effects with some variations in their kinetics. CNQX, an antagonist for non-NMDA receptor subtypes, failed to affect the JOR. The results suggest that long latency JOR requires activation of NMDA receptors, while the early component elicited by periodontal afferents does not. These NMDA-receptors could belong either to JOR interneurons activated by tooth pulp afferents or to digastric motoneurons, receiving the inputs through a polysynaptic pathway. Recent anatomical results favour the first hypothesis while not excluding the second.

[Electrophysiological study of the blink reflex in Wistar rats]. / Etude électrophysiologique du réflexe de clignement chez le rat Wistar.

The electrophysiological characteristics of the blink reflex evoked by electrical stimulation of supraorbital nerve (V1) have been studied in the awake and anaesthetized rat. This reflex has two components (R1 and R2). The first one, R1, is of short latency, strictly ipsilateral to the stimulus and exhibits all features of an oligosynaptic reflex response. The second component, R2, of longer latency, is observed bilaterally in awaked but ipsilaterally in lightly anaesthetized and totally depressed in deeply anaesthetized animals. This component possesses all characteristics of a largely multi-synaptic reflex response.

Transcranial electrical stimulation with Limoge's currents decreases halothane requirements in rats. Evidence for the involvement of endogenous opioids.

Transcutaneous cranial electrical stimulation with Limoge's currents has been shown to facilitate anesthesia/analgesia in surgical patients. However, the neurobiologic substrate of this effect remains unknown. The present study was designed to analyze the influence of transcranial electrical stimulation (TCES) on halothane requirements in rats and the contribution of the central endogenous opioid, alpha 2-adrenergic and 5-hydroxytryptamine (5-HT1 and 5-HT2) serotonergic systems to this effect. The influence of TCES on the MAC of halothane (MACH) and its reversibility by a subcutaneous 2 mg/kg naloxone injection were first determined in 20 rats using a randomized blinded protocol. MACH was decreased markedly in stimulated animals (TCES, n = 10) in comparison with sham-operated nonstimulated rats (controls, n = 10): MACH = 0.60 +/- 0.15, mean +/- SD, versus 1.07 +/- 0.05 vol%, P less than 0.001. In TCES animals, naloxone administration restored MACH values to the levels of controls but failed to affect MACH in controls. The influence of the duration of TCES applied prior to MACH determination was further investigated in 30 animals. The magnitude of MACH reduction was significantly increased with the cumulative duration of stimulation. For each duration of stimulation tested, administration of a 5-micrograms intracerebroventricular (icv) dose of the enkephalinase inhibitor thiorphan significantly enhanced TCES effects (P less than 0.05). Finally, the icv administration of a 15-micrograms naloxone dose appeared to reverse completely the MACH reduction elicited by TCES (n = 8, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Demonstration of glutamate in primary sensory trigeminal neurons innervating dental pulp in rats]. / Mise en évidence de glutamate dans des neurones sensitifs primaires trigéminaux innervant la pulpe dentaire, chez le rat.

Primary sensory trigeminal neurons supplying the dental pulp of incisors in rats were labelled by retrograde axonal transport. Using an auto-metallographic intensification procedure, 48 hrs. after injection of wheat-germ colloidal gold in the pulp, gold particles were detected in the cytoplasm of the neurons as black granulations. Glutamate was found in 45-60% of the neurons by submitting ganglion slices to an anti-glutamate immuno-serum revealed by immunocytochemistry. Among the neurons supplying the dental pulp of incisors by their peripheral process, 70% are Glu+, 30% Glu-. These observations suggest that the population of neurons supplying the dental pulp is not functionally homogeneous and that Glu- neurons use a different neurotransmitter. The coexistence of Glu+ and Glu- neurons could also indicate that glutamate expression is modulated during the life of these neurons.

Localization of 28 kDa calbindin in human odontoblasts.

The presence of 28 kDa calbindin in human odontoblasts was studied by use of specific antibodies raised against chick duodenal 28 kDa calbindin, in immunofluorescence, immuno-peroxidase, and electron-microscopic labelling experiments. The calbindin-like protein was detected mainly in the cytoplasm of odontoblast cell bodies, in their processes and occasionally in their nuclei. Correspondingly, at the ultrastructural level, immunoreactive material was associated with the cytosol, microfilaments and cilia. These findings suggest that human odontoblasts express a 28 kDa vitamin D-dependent calcium-binding protein, unlike those of rats and mice in which ameloblasts are the only cells immunoreactive for the protein.

Afferent fibres in cat ventral roots: electrophysiological and histological evidence.

Electrophysiological experiments using averaging techniques, as well as anatomical experiments using horseradish peroxidase staining, have provided further evidence of afferent axons in lumbosacral ventral roots of cats. Recording from dorsal root filaments in L7, S1 or S2, following stimulation of the companion ventral root close to the dura, often shows action potentials of slow conduction velocity belonging to the A delta or C group. Stimulation applied to the proximal part of the ventral root failed to evoke such responses. Recording from multiple sites along a centrally cut ventral root filament shows responses of two types: action potentials of long latency to peripheral nerve stimulation which are seen at all recording locations and which are not seen following dorsal root stimulation. These appear to be afferent fibres which enter the cord via the ventral root; action potentials which follow dorsal root stimulation and which are usually seen only at the most distal ventral root recording site. Some of these were also activated by stimulation of some skin or muscle nerves. At appropriate intervals collision of impulses from dorsal root or peripheral nerve can be demonstrated. Such axons appear to have a recurrent course in the ventral root. Section of the spinal nerve at points progressively closer to the dorsal root ganglion abolishes the dorsal to ventral root continuity of most recurrent type axons at 2 mm distal to the ganglion. Following application of horseradish peroxidase to crushed ends of distal stumps of cut dorsal roots, thin fibres marked by the enzyme are observed in the distal part of companion ventral roots. U-turns of axons have been observed in the distal part of ventral roots and in the spinal nerve near the pole of the ganglion.

The properties of cells in the cat trigeminal main sensory and spinal subnuclei activated by mechanical stimulation of the periodontium.

Neurophysiological exploration of the trigeminal sensory complex was done on 42 cats under ketamine anaesthesia, paying special attention to units receiving a periodontal input. Among 492 cells recorded in the trigeminal sensory complex, 73 responded to mechanical stimulation of the periodontium and were precisely localized histologically. Thalamic stimulation was also delivered to the ipsi and contralateral ventro-posterior nucleus to test for antidromic responses. Results of this systematic study were plotted on reference drawings of the full extent of the trigeminal sensory complex.